Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing最新文献

{"title":"Atrial helix-fixation leadless pacemaker: real-world single-chamber implant experience.","authors":"Devi G Nair, Ken W Lee, Nima Badie, Leonard Ganz, Kyungmoo Ryu, Cyrus A Hadadi","doi":"10.1007/s10840-025-02041-8","DOIUrl":"10.1007/s10840-025-02041-8","url":null,"abstract":"<p><strong>Background: </strong>Single -chamber ventricular leadless pacemakers (LPs) are well established. A dual-chamber LP system has recently become available with distinct atrial and ventricular devices. Single-chamber atrial pacing with transvenous devices is infrequent due to future upgrade concerns. This multi-center study evaluated the initial real-world use of the atrial LP by itself to treat isolated sinus node dysfunction (SND).</p><p><strong>Methods: </strong>SND patients with normal PR interval and AV conduction to be implanted with atrial LPs after commercial US release were consecutively included. Procedural characteristics were evaluated, and electrical parameters were measured during pre-fixation mapping, post-fixation tether mode, after LP release, and before patient discharge. Acute, 30-day procedure- or device-related complications were noted.</p><p><strong>Results: </strong>Aveir AR devices were implanted per standard local practice (N = 75 patients; 3 centers; 72 ± 13 years; 52% male; 92% de novo) with 100% success and placed predominantly in the right atrial appendage base (83%). The total procedure duration (from first incision to final suture) was 36 ± 33 min and the cumulative fluoroscopy duration was 7 ± 8 min. Pre-fixation mapping made repositioning unnecessary in 95% of implants. Pacing capture threshold at 0.4 ms pulse width, sensed amplitude, and impedance values of 0.6 ± 0.6 V, 2.9 ± 1.5 mV, and 329 ± 46 Ω, respectively, were measured prior to patient discharge. Capture threshold and sensed amplitude had improved significantly from LP release to patient discharge. No acute complications were observed.</p><p><strong>Conclusion: </strong>This initial real-world experience implanting the helix-fixation, single-chamber, atrial LP in SND patients demonstrated safe and efficient implantation, clinically acceptable electrical metrics, and no acute complications.</p>","PeriodicalId":520675,"journal":{"name":"Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing","volume":" ","pages":"1319-1325"},"PeriodicalIF":2.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12399728/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144163302","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Coronary venous occlusion by prior catheter ablation within the coronary venous system: a potential risk of precluding branch mapping and adjunctive chemical ablation.","authors":"Yasuhiro Shirai, Shinya Shiohira, Takeshi Sasaki, Yuhei Kasai, Takayuki Kitai, Tatsuaki Kamata, Mihoko Kawabata, Kaoru Okishige, Tetsuo Sasano, Kenzo Hirao","doi":"10.1007/s10840-025-02107-7","DOIUrl":"10.1007/s10840-025-02107-7","url":null,"abstract":"<p><p>We present case series of coronary vein occlusion by prior radiofrequency (RF) ablation within the coronary venous system (CVS). Case 1 was treated with endocardial RF ablation at the anatomically adjacent site to the earliest activation site identified by mapping of the annular branch which branched off proximally to the occluded site. In Case 2, attempted ethanol infusion to the septal perforator could not be performed due to occlusion of the CVS at the point where RF energy was delivered during the prior procedure. Our case series raise an issue regarding the workflow of ablation therapy for epicardial/intramural ventricular arrhythmias.</p>","PeriodicalId":520675,"journal":{"name":"Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing","volume":" ","pages":"1151-1157"},"PeriodicalIF":2.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144791780","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety of non-anesthesiologist positive pressure ventilation and sedation/analgesia during cardiac electrophysiology (EP) procedures in high-risk patients with known or risk factors for obstructive sleep apnea (OSA).","authors":"John D Fisher, Thomas Aldrich, Linda Lewallen, Jason Adkins, Mohammad H Mustehsan, Yvette Ash, Marjan Rahmanian, Suzanne Knowlton, Vanessa Taylor, Marianne O'Shea, Vilma Joseph","doi":"10.1007/s10840-025-02044-5","DOIUrl":"10.1007/s10840-025-02044-5","url":null,"abstract":"<p><p>Concerns exist about the safety of non-anesthesiologist positive pressure ventilation with sedation/analgesia during cardiac electrophysiology (EP) procedures in high-risk patients with known or risk factors such as obstructive sleep apnea (OSA). This is magnified if the procedures are done outside of intensive care areas or outside of hospital policies and procedures rules.</p><p><strong>Background: </strong>Noninvasive positive pressure ventilation mask ventilation (NIPPV including continuous or bilevel positive airway pressure-CPAP/BiPAP) with sedation/analgesia is typically limited to hospital units staffed by pulmonary-intensive care or anesthesiology personnel, with monitoring by respiratory therapists or specifically trained nursing staff. NIPPV with sedation has raised concerns if delivered by laboratory staff in procedure rooms, especially in high-risk patients. Literature is sparse on this topic. NIPPV as described is routine at some institutions and prohibited at others. We aimed (1) to test the safety and efficacy of NIPPV with sedation prescribed by cardiologists and administered by trained nurses in a prospective cohort of high-risk patients and (2) to provide data that, if favorable, could lead to revisions of institutional policies.</p><p><strong>Methods: </strong>We enrolled 50 consecutive consenting patients with known or at high risk for OSA. Three were then excluded (did not qualify, or procedure canceled). Procedures in 47 patients included 21 ICD implants (12 with defibrillation testing), 8 pacemaker implants, 11 ablations, and 7 cardioversions; some patients had combined procedures, e.g., \"ablate & pace.\" Standard NIPPV settings were used. Staff were trained in general NIPPV device monitoring and management. Data collected included vital signs, O₂ saturations, hypercapnia, demographics, toleration of NIPPV, and complications.</p><p><strong>Results: </strong>There were no NIPPV-related complications and no long-term adverse sequelae in the 47 patients who participated in the protocol. No patient required intubation or urgent rescue from an anesthesiologist. Most patients (45) tolerated NIPPV including patients without prior experience.</p><p><strong>Conclusions: </strong>NIPPV with sedation can be safely delivered in high-risk OSA patients by trained non-anesthesiologist/pulmonary/intensive care personnel in an EP lab setting. Policy and procedure manuals may benefit from revision.</p>","PeriodicalId":520675,"journal":{"name":"Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing","volume":" ","pages":"1327-1337"},"PeriodicalIF":2.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12399687/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144188787","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Same-day discharge versus overnight stay after pulmonary vein isolation: an assessment on clinical outcomes and healthcare utilization.","authors":"S R Stacey Slingerland, Jlpm Maarten Van den Broek, D N Daniela Schulz, G J Gijs van Steenbergen, Lrc Lukas Dekker, A J Alexandre Ouss, D Dennis van Veghel","doi":"10.1007/s10840-025-02077-w","DOIUrl":"10.1007/s10840-025-02077-w","url":null,"abstract":"<p><strong>Background: </strong>Atrial fibrillation is increasingly prevalent and constitutes a severe economic and clinical burden. Pulmonary vein isolation (PVI) is an effective treatment. Evidence on the safety of same-day discharge (SDD) after PVI, instead of overnight stay (ONS), is limited.</p><p><strong>Methods and results: </strong>This retrospective study uses data from PVI's performed between June 2018 and December 2020 in the Netherlands. Baseline characteristics, clinical outcome data, and healthcare utilization, extracted from two national databases, were compared between the implementation of an SDD protocol in a single center and a national benchmark where the majority is an ONS strategy. Descriptive and bivariate analyses were performed. We included data from 11,812 PVI's,1360 in the SDD protocol group, and 10,452 for the ONS benchmark. The SDD protocol group performed 57.7% of PVI's in SDD, while the benchmark performed 5.3% (p < 0.001). The SDD protocol group performed more cryoballoon PVI (90.8% vs. 39.2%, p < 0.001). There were no differences in bleeding (p = 0.830), thromboembolic (p = 0.893), vascular complications (p = 0.720), or cardiac tamponade (p = 0.634). Peri-procedural hospital stay was significantly shorter in the SDD protocol group (0.50 day vs. 1.52 days, p < 0.001), without a reallocation of health care to outpatient clinic (p = 0.230), emergency department (p = 0.132), or a higher rate of readmission (p = 0.092).</p><p><strong>Conclusion: </strong>The SDD protocol group with 57.7% SDD has similar complication rates and lower healthcare utilization, compared to the national ONS benchmark with 5.3% SDD, indicating that the SDD protocol is a safe and effective alternative for ONS in patients undergoing PVI. The implementation of an SDD protocol results suggests a potential reduction of nationwide healthcare utilization.</p>","PeriodicalId":520675,"journal":{"name":"Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing","volume":" ","pages":"1351-1357"},"PeriodicalIF":2.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12399697/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144328433","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Significance of coherent mapping in unveiling slow conduction zones of ventricular tachycardia substrate in ischemic cardiomyopathy.","authors":"Kivanc Yalin, Baris İkitimur, Ali Ugur Soysal, Hakan Yalman, Arda Ceviker, Sukran Nur Sanli, Ahmet Atil Aygun, Gunduz Incesu, Metehan Miroglu, Eymen Yogurtcu, Selin Ismailoglu, Sila Ozturk, Osman Talha Ercan, Hagai Yavin, Timothy Larsen, Paul Rhodes, Ahmet Kaya Bilge, Henry Huang, Tolga Aksu","doi":"10.1007/s10840-025-02066-z","DOIUrl":"10.1007/s10840-025-02066-z","url":null,"abstract":"<p><strong>Background: </strong>Identifying slow conduction zones (SCZs) within the ventricular tachycardia (VT) substrate remains a major challenge in ischemic cardiomyopathy (ICM). We aimed to evaluate the role of coherent mapping (CM) in identifying SCZs within low-voltage areas (LVAs) in VT substrate mapping and assess its impact on VT ablation outcomes.</p><p><strong>Methods: </strong>This retrospective study included 32 patients with ICM who underwent ablation for recurrent VT. CM-SCZs were compared with traditional substrate markers, including late potentials (LPs), local abnormal ventricular activities (LAVAs), and ILAM-based deceleration zones (DZs). Ablation strategies targeting CM-SCZs were analyzed in relation to procedural and clinical outcomes, including VT recurrence and total radiofrequency (RF) ablation time.</p><p><strong>Results: </strong>CM-SCZs were consistently identified adjacent to LVAs in all cases, with a mean area of 5.2 ± 2.3 cm². CM-SCZs colocalized with ILAM-based DZs in 56.3% of cases and overlapped with LPs and LAVAs in selected patients. Among patients who remained free from VT recurrence, total RF ablation time was significantly longer (938 ± 354 vs. 380 ± 448 s, p = 0.03), suggesting that more extensive substrate modification played a role in arrhythmia suppression. Furthermore, patients with VT recurrence had lower post-ablation non-inducibility rates (50% vs. 91.6%, p = 0.02).</p><p><strong>Conclusion: </strong>CM improves the identification of SCZ within the VT substrate and enhances substrate-based ablation strategies. Incorporating CM-SCZs into VT ablation protocols may improve procedural success and reduce arrhythmia recurrence. Future studies should validate these findings and explore role of CM in broader patient populations.</p>","PeriodicalId":520675,"journal":{"name":"Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing","volume":" ","pages":"1307-1317"},"PeriodicalIF":2.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144113288","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and safety of a novel diamond tip temperature-controlled catheter for left atrial posterior wall isolation under electrogram guidance.","authors":"Hirosuke Yamaji, Souhei Kawafuji, Masaya Sano, Shunichi Higashiya, Motoki Kubo, Takashi Murakami, Hiroshi Kawamura, Masaaki Murakami, Shigeshi Kamikawa, Satoshi Hirohata, Shozo Kusachi","doi":"10.1007/s10840-025-02084-x","DOIUrl":"10.1007/s10840-025-02084-x","url":null,"abstract":"<p><strong>Background: </strong>The effectiveness of a novel diamond tip temperature-controlled ablation (DTA) catheter for left atrial posterior wall isolation (LAPWI) remains unclear.</p><p><strong>Objective: </strong>This study evaluated the efficacy and safety of the DTA catheter for LAPWI under electrogram (EGM) guidance.</p><p><strong>Methods: </strong>This single-center observational study compared the first-pass LAPWI success rate among three groups: DTA with EGM guidance (n = 82), conventional irrigation catheter with EGM guidance (Irri with EGM guidance; n = 92), and Irri without EGM guidance (n = 93), using fixed energy parameters (30 W, 15-20 s).</p><p><strong>Results: </strong>DTA with EGM guidance had a significantly higher incidence of first-pass LAPWI success (93%, 76/82) than that of Irri without EGM guidance (54%; 50/93) (p < 0.001) and had a success rate comparable to that of the Irri with EGM guidance (97%; 89/92). Post hoc Bonferroni analysis demonstrated that the DTA with EGM guidance group had a significantly shorter radiofrequency-energy delivery duration (158 ± 63 s) than that of the Irri with EGM guidance group (229 ± 131 s; p < 0.0001) and the Irri without EGM guidance group (243 ± 185 s; p < 0.001). The DTA with EGM guidance group had a higher average RF power (45.1 ± 5.6 W) than the Irri with (31.2 ± 2.2 W; p < 0.0001) and without EGM guidance groups (28.0 ± 8.9 W; p < 0.001). No significant complications were observed.</p><p><strong>Conclusions: </strong>The novel DTA catheter with EGM guidance achieved a high first-pass LAPWI success rate. The novel DTA catheter with short energy delivery and high average radiofrequency (RF) energy delivery under EGM guidance can be effectively applied in LAPWI.</p>","PeriodicalId":520675,"journal":{"name":"Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing","volume":" ","pages":"1339-1350"},"PeriodicalIF":2.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144210728","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pulmonary vein isolation versus focused ganglionic plexus ablation: a meta-analysis of randomized controlled trials.","authors":"Justin Rackley, Matthew Nudy, Ankit Maheshwari","doi":"10.1007/s10840-025-02128-2","DOIUrl":"https://doi.org/10.1007/s10840-025-02128-2","url":null,"abstract":"","PeriodicalId":520675,"journal":{"name":"Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144986336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Atrial fibrillation ablation with a bidirectional block of the left atrial band.","authors":"Takafumi Sasaki, Rintaro Hojo, Koichiro Yamaoka, Hirofumi Kujiraoka, Tomoyuki Arai, Masao Takahashi, Seiji Fukamizu","doi":"10.1007/s10840-025-02114-8","DOIUrl":"https://doi.org/10.1007/s10840-025-02114-8","url":null,"abstract":"","PeriodicalId":520675,"journal":{"name":"Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144986327","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intracardiac echocardiography for left ventricular diastolic function assessment during atrial fibrillation ablation.","authors":"Jian Liang Tan, Julio Chirinos, Darshak Patel, Dinesh Jagasia, Matthew C Hyman, Gustavo S Guandalini, Saman Nazarian, David Lin, Gregory Supple, David S Frankel, David J Callans, Francis E Marchlinski, Jian-Fang Ren, Timothy M Markman","doi":"10.1007/s10840-025-02110-y","DOIUrl":"https://doi.org/10.1007/s10840-025-02110-y","url":null,"abstract":"<p><strong>Background: </strong>Left ventricular (LV) diastolic dysfunction is associated with the development of atrial fibrillation (AF) and risk of recurrence after ablation. The use of an intracardiac echocardiography (ICE) for diastolic function assessment during ablation procedures has not been evaluated.</p><p><strong>Objectives: </strong>To evaluate the feasibility and utility of ICE obtained measures of LV diastolic function including peak tricuspid regurgitation velocity, trans-mitral flow velocity, mitral annular tissue Doppler velocities, and pulmonary vein flow velocities in patients undergoing AF ablation.</p><p><strong>Methods: </strong>We conducted a single-center, prospective evaluation of patients undergoing AF ablation between 2022 and 2024. During sinus rhythm, diastolic parameters were measured with the ICE catheter and direct left atrial pressure (LAP) was recorded prior to AF ablation. Elevated LAP was defined as ≥ 12 mmHg. ICE measured diastolic parameters were compared with those measured on transthoracic echocardiography (TTE).</p><p><strong>Results: </strong>A total of 152 patients (53% male, 69 ± 12 years old, mean CHA₂DS₂-VASc score of 3 ± 2) were analyzed, of which 80 had normal LAP (< 12 mmHg) by direct measurement. Several ICE parameters were found to be significantly associated with mean LAP, including greater peak tricuspid regurgitation velocity (β = 3.5; p = 0.005) and average E/e' (β = 0.7; p < 0.001). In multivariable model, post-procedure intravenous diuretics were more commonly required in patients with abnormal diastolic function by ICE (mitral E/A OR = 8.1; average E/e' OR = 24.2).</p><p><strong>Conclusions: </strong>ICE can be used to assess diastolic function with traditional parameters correlating with both TTE diastolic function and LAP. ICE measures of restrictive filling are associated with the need for post-procedural intravenous diuretics.</p>","PeriodicalId":520675,"journal":{"name":"Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144986419","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical outcomes of pulmonary vein isolation versus antiarrhythmic drugs as first-line therapy for atrial fibrillation: a propensity score-matched analysis.","authors":"Yong Hao Yeo, Aravinthan Vignarajah, Hermon Kha Kin Wong, Nishanthi Vigneswaramoorthy, Jian Liang Tan, Beeletsega T Yeneneh, Luis Scott, Komandoor Srivathsan, Justin Lee, Dan Sorajja","doi":"10.1007/s10840-025-02117-5","DOIUrl":"https://doi.org/10.1007/s10840-025-02117-5","url":null,"abstract":"<p><strong>Background: </strong>Pulmonary vein isolation (PVI) has increasingly demonstrated superiority over antiarrhythmic drugs (AAD) for rhythm control in atrial fibrillation (AF). However, large-scale, long-term, real-world studies comparing these two therapies as first-line AF management remain limited.</p><p><strong>Methods: </strong>Using the TriNetX network, we identified patients (≥ 18 years old) with AF between 2012 and 2019. Patients were categorized into two cohorts: PVI vs. AAD as first-line therapy for AF. Patients were followed for 5 years, with the primary outcome being a composite of all-cause death, all-cause hospitalization, and heart failure exacerbation. Secondary outcomes included ischemic stroke and major bleeding events (intracranial bleeding/ gastrointestinal bleeding). Subanalyses were performed in the paroxysmal and persistent AF cohorts, respectively.</p><p><strong>Results: </strong>Among 342,230 eligible patients, 2,638 patients (mean age 64.3 ± 10.6 years) who underwent PVI and 2,638 patients (mean age 64.2 ± 13.1 years) who had AAD as first-line therapy for AF had similar propensity scores and were included in the analysis. At 5-year follow-up, the PVI group had a lower risk of the primary composite outcome compared to the AAD group (42.0% vs. 51.1%; HR 0.76; 95% CI, 0.71-0.83; P < 0.01). They also had lower risk of all-cause mortality (4.1% vs. 7.7%; HR 0.53; 95% CI, 0.42-0.67; P < 0.01), all-cause hospitalization (35.1% vs. 42.2%; HR 0.77; 95% CI, 0.71-0.84; P < 0.01), and heart failure exacerbation (21.0% vs. 24.3%; HR 0.85; 95% CI, 0.76-0.95; P < 0.01. Ischemic stroke (6.1% vs. 6.7%; HR 0.90; 95% CI, 0.73-1.12; P = 0.34), and major bleeding event (4.3% vs. 5.3%; HR 0.80; 95% CI, 0.62-1.02; P = 0.08) were similar between groups. Similar outcomes were seen in both the paroxysmal and persistent AF cohorts.</p><p><strong>Conclusion: </strong>After a 5-year follow-up period, PVI was associated with better clinical outcomes than AAD as first-line therapy for AF.</p>","PeriodicalId":520675,"journal":{"name":"Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144986368","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}